Cryonics, February 1985
BRINGING DIXIE BACK A RESEARCH DIARY
by Mike Darwin
The following is presented for those who wonder what it's like to do research work at ALCOR. To a great extent I think it's like doing research work anywhere; it's a lot of hard work consisting most of boring waits interspersed with periods of tedious concentration. It is also challenging, exciting and rewarding. It takes stamina and patience.
Few of the Suspension Members out there who do not come to ALCOR meetings or research sessions have any idea what the people who participate in research go through. I think fewer still of the Suspension Members really understand the outstanding dedication and perseverance shown by Suspension TEAM Members (for whom the rewards in no way compensate for the effort put in).
DECEMBER 8, 1984.
It's 1:00 AM. and I'm lying in bed trying to get some sleep. Wondering, worrying. Another Total Body Washout (TBW) experiment starts a scant six hours from now. Despite the fact that we've had three successes my mind is full of restless doubts. Did I remember to do everything? Will everything go smoothly? Will there be any equipment failure at a crucial time. What will the morning and the following 48 hours hold? Will she live? I've grown to like her. She's gentle and obedient -- full of life. I hope she lives. I've got to get some sleep. Once the experiment starts it will be at least 20 hours before I can hope to close my eyes -- if everything goes well. If. . .
I get up, find my way into the bathroom without turning on the light. Turning on the light will wash away the fatigue I've begun to feel (which is my main chance for sleep). It's been a grueling three days just getting ready. I open the medicine cabinet and find the Valium. Thank god they make them with a distinctive shape: perforated with a heart-shaped "V" in the middle. I don't have to turn on the light. Just feel for the hole in the middle and swallow it. A dangerous drug, very seductive. It quiets all the noise, turns the acid rock stereo off. Dangerous. Reserved only for nights like this when I absolutely have to get to sleep -- and can't.
7:30 AM. The alarm. Get into scrub clothes. Grab a couple slices of bread and a jar of baby food. Get down to the ice house and pick up the ice for the experiment.
8:30 AM. Jerry Leaf and Hugh Hixon are the only ones at the lab. Jerry is slowly stringing out the perfusion circuit on the heart-lung machine. He's wearing a mask, so it's one of the few times he's not enveloped in a cloud of smoke. Cigarettes and coffee = Jerry Leaf. Hugh Hixon is doing a final calibration run on the blood gas machine. Last night he slept at the lab. I interrupt him to get a last minute pH on the perfusate.
Dixie, our experimental animal, gets her shot of Tagamet and some Thorazine. The latter to calm her down during the uncomfortable procedure of putting in an I. V. so we can anesthetize her. She is glad to see me and the cage rumbles with the steady thwack, thawck, thawck of her tail. She is very surprised at the injections. She looks very hurt and a little angry. I try to give her some extra attention. She seems mollified, quickly forgetting the discomfort.
10:30 AM. The rest of the team starts to straggle in at their appointed times. Al Lopp, reliable as usual, shows up with "provisions" for the day: lunch meat, fruit, bread, and soft drinks. I worry over the spartan fare. These people have shown up weekend after weekend. I wish we could afford something a bit more exciting than Honey Loaf and Kraft Lite Cheesefood Singles. They must be bored silly with the food. Better food would seem the least we could do. The checkbook says otherwise.
11:50 AM. Dixie is out cold. A little bit of trouble getting the I.V. in, but then swift darkness for her. Little does she realize what's about to happen, the incredible technical and yes, even human, drama which is about to swirl around her. She is simple. Her thoughts, if any, no doubt centered around her missed meal. No usual morning can of dog food -- no water in her cage. Simple thoughts -- then darkness.
There is a perceptible difference in the team. They know the routine. People flow from task to task. Things move smoothly. Dixie's heart beeps out into the room at a 126 beats a minute. Scott Greene and I start packing her in ice. Sherry Cosgrove faithfully takes notes. These sessions are quieter now, and more professional than when we first began them. Who knows, maybe I will get frozen by people who know what they're doing, should the need arise.
We have a team member who cancels. Hugh Hixon takes his place and scrubs in. Cancellations have been rare. This crew is professional. Carlos Mondragon begins to log Dixie's descent into deep hypothermia. The ice bags are doing their work. Jerry and Bill Jameson put the finishing touches on the heart-lung machine set up. The surgery begins. Dixie cools. The heart beeps slow to 90 times a minute.
2:13 PM. Dixie is on bypass. Jerry releases the clamps, Bill Jameson turns on the pump. Blood begins to flow through the heat exchanger, her blood pressure picks up as the roller pump takes over. A sigh of relief. The surgery is over, and she's on the blood pump. No complications so far, no danger of her continuing to cool while surgical difficulties stall connecting her to the pump. Her temperature begins to drop rapidly.
3:30 PM. She took longer to cool than the others. Her rectal temperature is 12.4 degrees centigrade, her esophageal 8.0. It's time to wash her out. The large bottle of honey colored liquid is brought into position. Corn starch, sugar, water and a few salts. The hundreds of dollars worth of ingredients sound so simple. They are to take the place of Dixie's blood for the next four hours. These "simple" ingredients are very unlike the blood they will replace. There is something of a thrill in realizing that no mammal has ever tolerated such drastic changes in blood and tissue electrolyte composition and lived -- before these experiments being carried out by ALCOR, that is. A tremendous sense of aesthetic satisfaction and power sweeps over me. Here we are washing the blood out of a warm blooded, nonhibernating animal and cooling her down to a few degrees above freezing. It is the fulfillment of a hundred science fiction fantasies of my youth. In a heavy German accent I comment to Jerry Leaf "Veell, Dr. Frankenstein, vashout appears to be proceedink smootly . . ."
3:44 PM. Washout is complete. She looks utterly dead. Her lips, tongue and eyes are ashen gray - devoid of any trace of the pink hue we associate with life. The pupils are massively dilated, the eyes begin to "cave-in" from the hyperosmotic perfusate. Her limbs and flesh stiffen as the fats in the tissues begin to freeze. It is quite difficult to inflate her lungs with the ambu bag. She looks as though she's been lying dead in a refrigerator for a day or two. Water from the air begin to condense on her tongue as her temperatures drops to 4.5 degrees centigrade. The respirator tubing fails to show the characteristic misting on exhalation. Indeed, her lungs are probably condensing water out of the air. Her temperature is just a few degrees above freezing. I begin my usual pessimistic diatribe "Now we've gone and done it, killed her. This dog is dead -- no way she's ever coming back, not after perfusion with liver and pancreas remover." Anna Tyeb examines Dixie and heartily concurs: "Dead!"
4:18 PM. The recirculation period is endlessly boring. Take readings, sit and watch. Someone has to be with her at all times making sure a cannula doesn't come out, or the oxygenator doesn't get pumped dry. Most of the team heads up front to the "office" to get some "lunch," shoot the bull and just relax. The tension sometimes is so thick it's almost suffocating. These things cost a couple of thousand bucks and besides, we want her to live. She deserves to live.
Sherry Cosgrove and I are the only two left in the O.R. The more I see of Sherry the more impressed I AM. She sticks with it, she is hard working, takes the initiative and gets the job done. Immensely competent. I begin to feel anxiety. We are growing quite rapidly to depend on her. My own insecurities make me aching to rely on people who don't drain you dry of energy supervising them. Sherry is a real self starter, an asset. What will we do if we lose her? When will she move away? I keep telling myself I should be grateful, look on the bright side. . . . But the grim reality is that poverty makes you dependant. ALCOR is small, vulnerable. There's no escaping the fact that ALCOR leads the kind of existence that many of us lead personally: we get by, barely, as long as the brakes don't go out on our cars, or the hot water heater doesn't die on us. We're surviving, but even a little setback is a real disaster.
I begin to get depressed. Frantic even. How in the hell is this supposed to work, save my life even, when I have to worry about things I can't control and sweat pennies for lunch expenses for the crew? It's hell being that dependent and that restricted. All I can do is hope, wish for luck, pray the brakes don't go out 'cause there ain't no money to fix 'em.
4:30 PM. I go up front and get a bite to eat. Several conversations are going on. I don't feel like getting involved in any of them. I carry my sandwich back to the O.R. and do a blood gas and pH. Her pH is way down to 6.99. I go up front and tell Jerry. I interrupt his smoke, he sets down the coffee and follows me back. We start a bicarb drip, push 50 cc more of bicarb into the oxygenator. The pH comes up. It isn't what we want, but it'll do.
7:55 PM. Her blood has been replaced, she's rewarming and I'm starting dialysis. This is the big moment for me when I have to perform and bring Dixie's electrolytes back to sane values, values she can, hopefully, live with. Blood courses through the artificial kidney, filling the thousands of hair-like fibers. I anxiously look for leaks. These kidneys are old. This one had "DROPPED: DISCARD" written boldly across it. Nothing to inspire confidence. There are no leaks. Those Germans make a good kidney. I crank the flow on the kidney machine blood pump up. The pace of her rewarming accelerates. Blood gas readings come in a steady stream now. Dialysate and blood pH are checked and rechecked, balanced and rebalanced. Soon now we'll know if we have saved her heart and lungs.
8:20 PM. Her heart begins to stir. Beat follows beat. A regular rhythm. Her heart has made it. At 8:30 PM. she comes off dialysis. Clear saline solution chases red blood back into the heart-lung machine tubing. There are smiles and some surprise -- her heart has started beating at 17.2 degrees centigrade!
8:46 PM. Her tongue is once again pink. She doesn't look "stiff and dead" any longer. A small thrill of excitement and satisfaction passes through me. She is beginning to make the long journey back to the land of the living. Her temperature is up to 24.4 degrees. Her paws are twitching with involuntary movement. There is slight twitching movement of her head. This sign is encouraging. But we are not overwhelmed with anticipation. If the past is any indicator these hopeful signs will disappear and there will be many hours ahead of long, lifeless quiet, without so much as a muscle moved to reassure us that she is still "inside there," as Anna says.
9:55 PM. She is not rewarming on her own very well. No shivering. Jerry puts her back on the heart-lung machine for more vigorous rewarming. She is quiet and still -- pupils constricted to pinpoints, eyes turned back in her head. This is the worst time, the very worst time. Waiting, hour after hour for the brain to regain its balance, and the magic of consciousness to return -- if it will return. I liken the procedure to a minefield. So many things can go wrong. She could bleed, she could simply not wake up. She could get infected if she does wake up. Or die of liver or pancreatic failure. It's a minefield.
10:35 PM. Her temperature is 34.3. Jerry takes her off the pump. More waiting. People are showing their fatigue. Most are huddled up front in the office working over the last of the food. Sherry Cosgrove stands guard in the O.R. I wander in and out. I'm very tired, but the kidney machine needs to be cleaned and bleached. I pull it out into the cold night air. Orion is shining high above. Even though it's California, my breath forms big misty clouds. Scott Greene comes out and lends a hand. This makes the work go a little faster. I wish I had more energy, I'd try to teach Scott how to do the whole wash procedure. Instead, I kind of bark things out occasionally -- not very effective. It's probably just as well. He's tired too.
10:50 PM. She's breathing on her own! None of the others have started spontaneous respiration so quickly. Maybe I won't be up all night after all. Wishful thinking.
11:50 PM. Corneal reflex: her eye blinks when you touch it. Barely. Progress. The brain has probably made it too!
12:30 PM. Jerry completes closing the wounds. The ranks have thinned out. Those with families (save for Jerry and Sherry) have split. It's nearly 1:00 AM. Pizza Hut closes at 1:00. It's a "free day" today, the one day a week I allow myself a liberal fat meal, i.e., cheese! Pizza's have become the treat I use to get myself through this aching time of worried anticipation. I call in the order and run over to pick it up. The girl in the restaurant who takes my money looks at my scrub clothes uneasily, fixing her eyes on the mask dangling around my neck. They've heard what goes on over at Cryovita. Body freezing!
It isn't a New York pizza, but it's great. Scott and I share a medium. I eat about 3/4ths of it. He's probably feeling worse about his two slices than I am about my six or eight, and this makes me feel better. Misery loves company.
5:05 AM. Dixie is awake. Lifting her head up, fighting the endotracheal tube. Very restless. At 5:20 she has her way and we pull her stomach tube and tracheal tube. Time for me to get some sleep. I'll need it. I'll be relieving Jerry in the afternoon. He can go well over 24 hours with no sleep and not sweat it. Coffee and cigarettes-the secret of supermen everywhere. Maybe I should think about it. . .
12:30 PM. The alarm goes off. Where AM I? Totally disoriented. Where are the doors and windows. What a strange thought to have. Well, up and at em! A shower. Skip shaving. Where I'm going no one will care. The shower feels incredibly good. Like washing a week's worth of dirt off. Fresh clothes. Go forth and conquer!
1:00 PM. She's still very weak, but I'm impressed by her progress. She's drinking Ensure (liquid nutrition) from a bowl instead of needing to be fed from a squeeze bottle like Enkidu and Bear, our other four-hour survivors. Still, 1:00 PM. She's still very weak, but I'm impressed by her progress. She's drinking Ensure (liquid nutrition) from a bowl instead of needing to be fed from a squeeze bottle like Enkidu and Bear, our other four-hour survivors. Still, she's a handful. She exhibits a peculiar "windmilling" motion with her forelegs. Suddenly, she tenses, the left side of her body goes rigid. Within a second she has a full-fledged grand mal seizure. She recovers quickly, but the windmilling, which I'm told has been going on all morning, continues. She responds to her name. She drinks a couple of cans of Ensure liquid food. This is the first time we've seen anything like seizures in any of our animals. 2:50 PM. Another grand mal. This is looking bad. There is clearly some right brain injury. Her left face is slack, though her left limbs look okay with normal movement and response to pain. We start her on Valium to control the seizures.
5:38 PM. Another grand mal, several petit seizures as well. More Valium, and we load her onto a gurney for a visit to the emergency pet clinic a few blocks away. The vet gives us a prescription for primadone -- a more potent medication to control the seizures. Scott relieves Hugh and me for a dinner break. He has finals the following day. He spreads out his books and papers and begins to study. I don't envy him. Hugh and I head off into town to the Spaghetti Factory. What a relief just to be away for a few hours. Everything is so elegant at the restaurant and all the personnel are so clean cut and attractive. I mentally consider what the personnel ads must read like: "Young and irresistably attractive? Sought after to do covers for Gentlemen's Quarterly and Teen? Looking for an exciting job in a spaghetti restaurant. . ." I decide that the premium on good looks must be lower than I thought. After a relaxing wait we are shown to our table by a sincerely smiling young woman who leaves a warm glow and two glasses of cold water in her wake.
Returning from dinner we find Dixie is a real handful -- managing her I.V.'s, keeping her fed, cleaning her up when she urinates or defecates. Every five minutes there's a major task at hand.
11:26 PM. The primadone isn't working. Seizures, seizures and more seziures. Valium, Valium, and Valium. They're wearing both her and us down. I decide to start her on pentobarbital -- the only barbituarate we have.
12:00 PM. Resting quietly. Control at last -- we hope.
3:00 AM. The night is passing in a haze. I fall asleep only to be reawakened a minute later. I am overwhelmed by anxiety that she might pull her I.V. out. We are all exhausted. Scott has gone home. He has class in the morning at around 8:00 AM, with finals. It's going to be a rotten day for him too.
8:30 AM. She ate some lunch meat. Seizures look well controlled.
11:30 AM. Hugh spells me, and I run home for lunch. He heads out to Wendy's when I return.
7:17 PM. Dixie's abdomen is distended. Her bowel sounds are diminished. What's going on?
12:00 midnight. She wakes me up crying. Belly very distended.
DECEMBER 11, 1984
1:20 AM. She vomited about 150 cc of partially digested food. It gives her a little relief. I get the sinking feeling we're going to lose her after all.
1:36 AM. She's restless and crying again. I decide to pass a stomach tube and suction her. Hugh is sound asleep, exhausted. I decide not to wake him. I'll try it alone. She fights me powerfully, but the job gets done. She seems almost grateful for the distraction. I get about 400 cc of stomach contents. Back to sleep.
4:00 AM. She's restless again. Time for pain and seizure medication. Back to sleep for both of us this time.
5:00 PM. Eating well. Stomach doesn't look good, bowel sounds diminished. Is she obstructed? Necrotic bowel? Or just delayed emptying?
6:30 PM. I drive down the 57 Freeway to Veterinary Labs to get her lab work. It's raining and the weather is hideous. The lab tech who handles our work looks over the results with me in the lobby. I settle down in my truck under the dome light trying to make sense out of the numbers. Just like the others, we've injured about every organ system we can evaluate. Liver, pancreatic, and other tissue enzymes are sky-high. Nothing unusual, though. In fact it looks good, as things go.
Another night like the one before. Very restless. Very little sleep for either of us. If we back off on barbiturate medication she seizes. Progress at this point is well behind that of Bear and Enkidu.
DECEMBER 12, 1984
12:40 AM. Hugh and I suction 1,800 cc from her stomach. Looks like an obstructed bowel or maybe a side effect of barbiturates. In any event we need to get a central venous line in and start her on hyperalimentation: complete I.V. nutrition.
2:10 AM. Grand mal. Valium required to break it.
6:30 AM. Jerry shows up to do the cut-down. Jerry looks like hell, almost as bad as Hugh and me, and we've been up for an hour or so getting things ready. I feel very concerned for Jerry. He has had to delay going into work in order to come out to the lab. Despite the fact that's he's obviously had very little sleep he'll have to follow his morning at Cryovita by a day at work.
The goddamn sterilizer won't work! It keeps losing pressure through the relief valve. Hugh tears it down and finesses it into working. When I bought the thing they warned me not use it for anything but parts. I now see why.
11:30 AM. She's semiconscious from the anesthetic we gave to put the jugular line in. The line is in place and we've got hyper-al running. She's stable enough to transport to the vet for an upper GI (Gastro-Intest- inal) X-ray series. It's going to be a long, long day.
12:30 PM. The first film shows delayed gastric emptying. She's still very lethargic and responds only to vigorous stimuli. Even though it's supposed to be ultra-short acting, the anesthetic really zapped her. No doubt her liver isn't up to snuff. With an SGOT of 1198 (80 is normal) I can see why her liver isn't doing cartwheels in getting rid of the anesthetic.
6:00 PM. Films show very slow filling of the gut. We'll have to bring her in at 6:00 AM tomorrow and get a final film. Back home she goes.
6:30 PM. She hasn't urinated in 12 hours. Her bladder is distended. She proves difficult to catheterize. I feel very sorry for her. Sorry that she has to suffer the discomfort. As I stroke her head I notice the beginning age spots and middle aged appearance of the skin on my hands. My resolve strengthens. I want to live pretty badly. With luck and hard work maybe both of us will make it through this.
7:00 PM. I head out to our favorite haunt for Chinese food. When I return we set up a card table in the O.R. where we've camped out, and have dinner. Outside the wind is howling and the rain is pounding on the plastic skylight. It's "bitterly" cold by California standards. We have a space heater running in the O.R. The O.R. feels very warm and safe inside.
2:00 AM. Jerry comes out with a text on dog anatomy. We succeed in getting her catheterized after several unsuccessful attempts. We get 1900 cc of urine via the pilot catheter and then we pass a guidewire and put in a more permanent foley catheter. The barbiturate is interfering with both her bowel and bladder function. We are exhausted. Hugh and I crash. The sleeping bag I crawl into on the egg-crate foam never looked so good.
3:30 AM. Now I have two catheters to worry about her pulling out -- I.V. and bladder. She is up, down, and around on her forelegs all night long.
6:00 AM. The vet is late, he overslept. Wish we'd known! God do we need some sleep. It's been a couple days since we've showered and I've got a two day growth of beard. I look very, very disheveled. I wonder what the office girls think. Drug addicts?
7:00 AM. Film looks good. There's barium all the way to her butt! No obstruction. She'll probably live. But will we. . . ?
Dixie did live. But she gave us a good deal more excitement before she was done with us. She developed a seroma, a tumor-like, fluid filled sac at the site of one of her wounds, and this necessitated more surgery. She also developed bone marrow suppression from one of the antibiotics she was on. Gradually her seizures resolved and she was taken off medication.
As of January 3rd she is doing well: eating, running, and getting into mischief, although, she isn't back to normal yet. Her balance is still not good and her coordination is spotty. We think it very likely she sustained some damage to the motor area of her right brain. Only time will tell if these things will resolve. In the meantime, she remains with us, well cared for and given plenty of attention, fresh air, and love.